Pediatric Orthopaedics

At the conclusion of the residency rotation on this service, the graduate is expected to be proficient in the management of pediatric orthopaedic conditions and their associated rehabilitation encountered in the general practice of orthopaedics. It is important to recognize that competency as a physician extends beyond medical knowledge and direct patient care. Therefore, evaluations for the Pediatric Orthopaedic Service will include not only these competencies, but also demonstration of abilities in medical knowledge and patient care, interpersonal and communication skills, professionalism, practice-based learning and improvement, and systems-based practice.

Reading List

The Reading List can be found on the Department of Orthopaedics and Rehabilitation Intraweb under the Residency/Curricula section.

Goals and Objectives

Medical Knowledge and Patient Care:

It is expected that junior level residents on the Pediatric Orthopaedic Service will:

Learn the natural history and assessment of angular and torsional deformities as well as understand the indications for orthotic and operative treatment for these deformities.

Have a clear understanding of the evaluation and management of childhood and adolescent hip disorders (DDH, LCP, SCFE).

Understand the evaluation and treatment of a child with a limp.

Become familiar with assessment and management of back pain in the child and adolescent, and how it differs from an adult presentation.

Learn the assessment of common foot problems in the pediatric patient. These include clubfoot deformities, lesser toes deformities, metatarsus adductus, flexible flat feet, juvenile hallux valgus, congenital vertical talus, and cavovarus foot deformities. The non-operative management and operative indications for each of these problems should be understood.

Understand the management of common pediatric fractures, including the indications for closed and open reduction. Understanding role of remodeling in pediatric fractures.

It is expected that senior level residents on the Pediatric Orthopaedic Service will:

Understand the comprehensive evaluation and multidisciplinary management of neuromuscular disorders such as cerebral palsy, muscular dystrophy, and myelomeningocele. The indications for orthotic treatment and operative procedures specific for each individual disorder must be appreciated.

Have a clear understanding of rehabilitation of common pediatric and adolescent hip disorders, traumatic brain injuries, and neuromuscular disorders such as cerebral palsy and myelomeningocele.

Understand clinical gait analysis and common abnormal gait patterns.

Become familiar with the evaluation and management of pediatric spinal deformities, including the indications for orthotic and operative intervention. These deformities include idiopathic scoliosis, congenital and neuromuscular scoliosis, and Scheuermann’s kyphosis.

Understand the clinical and radiographic presentation of common pediatric tumors, benign and malignant; their diagnostic work-up, staging, and operative indications.

Know the assessment and etiologies of limb length discrepancies (LLD) in children, use of the Moseley straight-line graph to determine LLD at skeletal maturity, and the indications and options for operative intervention.

Know the assessment, prioritization, and management of pediatric polytrauma. Understand the indications for open reduction and internal fixation in children with multiple fractures associated closed head injury, and articular fractures.

Interpersonal and Communication Skills – Goal: Both junior and senior level residents will be expected to be respectful to patients and all members of the health care team at all times. This includes the following objectives:

Both junior and senior level residents will demonstrate the ability to discuss difficult matters with patients and families in a compassionate manner. The level of discussion should be commensurate with the medical knowledge and experience of the resident.

Both junior and senior level residents will demonstrate the ability to allow patients and families to fully express their concerns and/or symptoms.

Both junior and senior level residents will demonstrate the ability to explain operative procedures, risks and post-operative care to the patient/family, commensurate with their medical knowledge and experience.

Both junior and senior level residents will demonstrate the ability to develop a professional relationship with the patient/family.

Both junior and senior level residents will maintain professional communications and relationships with ancillary staff and medical colleagues.

Professionalism – Goal: Both junior and senior level residents will be expected to act professionally toward patients and all members of the health care team at all times. This includes the following objectives:

Both junior and senior level residents will demonstrate sensitivity and responsiveness to differences in culture, gender, age and impairments.

Both junior and senior level residents will demonstrate sensitivity to the needs of patients/families.

Both junior and senior level residents will respect the need for confidentiality of patient information.

Both junior and senior level residents will always demonstrate honesty in written and oral communications.

Both junior and senior level residents will demonstrate awareness of limitations and seek advice when appropriate.

Both junior and senior level residents will accept advice without personal offense and use it constructively.

Both junior and senior level residents will assess their performance with objectivity and accuracy.

Practice-Based Learning and Improvement: - Goal: Both junior and senior residents will demonstrate commitment to continuous learning and improvement in their patient care, benefiting from previous experiences and ongoing review of the literature, and contributing to the education of those around them. This includes the following objectives:

Both junior and senior level residents will contribute to the education of medical students and other health care professionals. Although senior level residents will provide the leadership in this, the more junior level residents can play a meaningful role as well.

Evaluate medical research/scientific evidence and apply findings to patient care. The more junior level residents will frequently utilize textbooks, review articles, and “classic” articles. More senior level residents will actively seek out more recent and perhaps “cutting edge” manuscripts that are applicable to patient care.

Both junior and senior level residents will monitor their own practice of medicine to identify opportunities for improvement.

Both junior and senior level residents participate in the morbidity and mortality process.

The resident, during their entire residency training, gradually assumes increasing levels of independence with decreasing need for faculty supervision, commensurate with the medical knowledge and patient care competencies outlined previously.

Systems-Based Practice – Goal: Residents will recognize their role in a complex and financially challenged health care system, identify resources available to them to contribute to patient care, and demonstrate familiarity with internal and external regulations and policies that impact care delivery. This includes the following objectives:

Both junior and senior level residents will complete medical records accurately and in a timely manner.

Junior level residents should be aware of the need to provide cost efficient patient care, and have a basic understanding of the factors that impact this. Senior level residents should have an advanced understanding of the costs associated with their treatment recommendations, and be able to justify treatment not only on medical decision making but cost considerations as well.

Both junior and senior level residents will assist patients in dealing with health care complexities and serve as advocates for patients within the health care system.

Both junior and senior level residents are attentive to the manner in which the health care system may impact patient safety and take steps to prevent errors. This includes awareness of National Patient Safety Goals and federal and hospital quality improvement projects.

Both junior and senior level residents are attentive to medication errors, surgical site infection and venous thromboembolic disease.

Both junior and senior level residents adhere to the standards of surgical site identification, awareness of wrong site surgery and adherence to surgical time out.